Deep Brain Stimulation for Essential Tremor

Abstract

Essential tremor (ET) is one of the most common movement disorders in adults. Several drugs have been proven as effective tools in the treatment of tremor associated with ET; however, their therapeutic efficacy varies in each patient. Irrespective of the pharmacotherapy, around 10 % of patients with ET experience severe tremor that causes a marked deterioration of their quality of life. So far, deep brain stimulation (DBS) has been applied and established as a powerful tool in the treatment of medically refractory tremor in ET patients. Its traditional target for ET is the ventral intermediate nucleus of the thalamus. During the recent years, there is a growing body of evidence suggesting that the posterior subthalamic area, which includes the zona incerta and the prelemniscal radiation, also serves as an alternative DBS target for ET, as does the subthalamic nucleus. Here, we introduce the current advances in understanding the pathophysiology of ET, the functional anatomy of the DBS targets for ET, and the possible mechanisms by which DBS suppresses tremor associated with ET. Overall therapeutic impacts and adverse effects related to the DBS surgeries for ET are also described. This review would help to gain more insight into the DBS surgeries in patients with ET.